What is circumcision?

Circumcision is a surgical procedure to remove the foreskin, a fold of skin covering the end of the penis.

The foreskin is a double-layered fold of skin and mucous membranes that protects the head (glans) of the penis from dryness and irritation that may be caused by contact with urine, feces, and clothing.

Circumcision is optional. Some parents choose to have it done and some don't. If you're considering it, here's more information.

How many boys are circumcised in the United States?

As of 2010 (the most recent information available), about 58 percent of baby boys in the United States were circumcised in the hospital at birth.

The procedure can also be done at home by a trained practitioner or in a doctor's office or other nonhospital setting, so the actual percentage of boys circumcised is probably higher. And most Jewish and Muslim families circumcise their sons, so the percentage is probably higher in those groups as well.

Worldwide, about 1 in 3 males is circumcised.

Why do some parents choose to circumcise their son?

Families may choose circumcision based on religious or cultural tradition, in response to concerns about health and hygiene, or simply because they want their son's penis to look like his dad's or other family members'.

Why do some parents choose not to circumcise their son?

Some parents consider circumcision unnecessary or not worth the risk of complications. Others think it's unethical to make this choice for their child before he can decide for himself.

What do health experts advise?

The American Academy of Pediatrics (AAP) does not recommend circumcision as a routine procedure for every newborn boy.

From the AAP: "Current evidence indicates that the health benefits of newborn male circumcision outweigh the risks and that the procedure's benefits justify access to this procedure for families who choose it."

The U.S. Centers for Disease Control (CDC) says: "Parents should be informed of the medical benefits – including reduced risk of future HIV infection – and the risks of male circumcision and should make decisions in consultation with a healthcare provider."

What are the health benefits of circumcision?

Circumcision may reduce the risk of urinary tract infections as well as cancer of the penis and some sexually transmitted infections. The AAP estimates that about 1 in 100 uncircumcised boys develops a urinary tract infection during his first year, while the risk is closer to 1 in 1,000 for circumcised boys.

Also, according to the CDC:

Circumcision may reduce the risk of cancer of the penis by as much as 30 percent. But this cancer is already rare, and the risk is further reduced for males who get the HPV vaccine (now recommended for boys at age 11 or 12).

Circumcision can reduce a man's risk of acquiring HIV during sex with an infected female partner by 50 to 60 percent. However, circumcision has not been shown to reduce the risk of male-to-male or male-to-female HIV transmission, which are much more common ways to become infected.

Circumcised men are 30 to 45 percent less likely to get genital herpes than uncircumcised men.

Rates of certain sexually transmitted infections, such as bacterial vaginosis, trichomoniasis, and human papillomavirus (HPV), are lower in female partners of circumcised men.

How does circumcision help reduce certain health risks? Experts hypothesize that the inner surface of the foreskin and the protected skin of the penis underneath are susceptible to tears (especially during sex) – and such tears provide a way for germs to enter the bloodstream.

The foreskin also creates a moist environment that's conducive to trapping and supporting the growth of bacteria and viruses.

What are the risks of circumcision?

Minor bleeding and swelling are the most common complications. Other less common problems include:

Adhesions, which can happen when residual foreskin sticks to the healing glans. This condition usually goes away on its own or with ointment.

A trapped penis, meaning the penis is encircled by a ring of scar tissue. If not treated, this condition can make it difficult to urinate and cause problems with hygiene and sexual function. A trapped penis is usually treated with steroid cream or surgery.

Infection, which is likely to be mild and treatable with antibiotics.

Severe complications are rare but can include:

Bleeding that doesn't stop with local pressure. This may require stitches.

As with any surgery, there's a small risk of sepsis, a dangerous blood infection.

Injury, such as the partial amputation of the head of the penis or the removal of too much skin. This might affect both the appearance and function of the penis.

Improper healing, which might lead to scarring or a shortening of the penis. This complication would cause an odd bend or shape of the penis or lead to discomfort when having an erection.

According to the World Health Organization (WHO), "When male circumcision is performed by well-trained, adequately equipped and experienced healthcare personnel, these complications are minor and rare, occurring in 1 of every 250 to 500 cases."

It's also possible for too much foreskin to be left behind, and you may not be happy with how the penis looks after the procedure. In that case, you'd need to need wait until your baby is at least 6 months old to have an additional procedure done (under general anesthesia) to remove the remaining foreskin.

Are there disadvantages to being circumcised?

Some people believe that removing the foreskin reduces sexual pleasure. Because a circumcised penis doesn't have a protective hood, over time the glans develops a toughened outer layer of skin, which some believe reduces sensation and sexual pleasure.

But according to both the CDC and WHO, men who undergo circumcision as adults generally report little or no change in sexual satisfaction or function.

What kind of practitioner does circumcisions?

The AAP recommends using a trained and competent practitioner, using sterile techniques and effective pain management such as a cream or an injection. According to the AAP, nonmedical comfort techniques like sucrose pacifiers and swaddling are not sufficient to prevent pain.

If your baby is circumcised as a newborn in the hospital, most likely the procedure will be done by a pediatrician or family physician. Ask how many circumcisions the doctor has performed. You're allowed to request that it not be done by a resident (a doctor in training). If you decide to allow a resident to perform the procedure, make sure an experienced doctor will be assisting.

Circumcision may also be done as part of a ritual or ceremony, such as khitan in the Islamic community or brit milah (bris) in the Jewish community. In Jewish tradition, circumcision is done by a mohel (someone trained in ritual Jewish circumcision) at home or in a synagogue.

How is circumcision done?

First, the doctor is likely to use a local anesthetic to numb the area either by giving your baby an injection in the base of the penis, or by applying a cream about an hour before the procedure.

The doctor holds the foreskin in place with a specialized ring or a clamp and uses a surgical knife to cut off the foreskin. In some cases, excess skin will need to be trimmed afterward. The procedure takes between 30 seconds and 10 minutes, depending on the method.

You can stay with your baby during the operation if you like. Comfort your baby by keeping your face close to his and perhaps singing him a lullaby. Hold him close and feed him when the procedure is over.

At what age can my baby be circumcised?

Infancy is usually the best time for elective circumcision because the foreskin is thinner. The procedure is often done before a baby leaves the hospital, but the timing may vary depending on religious or cultural beliefs.

For example, in Jewish tradition, circumcision is done when the baby is 8 days old. In some Islamic communities, circumcision is done in infancy, while in others it's carried out when the child is older.

Circumcision isn't usually recommended for premature babies until they're well enough to be discharged from the hospital. Premature babies who are circumcised too early have a higher risk of later complications, such as adhesions or a trapped penis.

Circumcision is sometimes done when a child is older because of medical problems related to the foreskin not retracting properly, for example.

Is circumcision covered by health insurance?

Some insurance companies cover newborn circumcision, but check your plan to be sure. Circumcision is covered by Medicaid in most states.

The AAP says the "preventative and public health benefits" associated with circumcision warrant coverage of the procedure.

What happens after my baby is circumcised?

After your baby has been circumcised, he may have some pain and swelling. Check with his doctor, but it's probably fine to give your baby acetaminophen if he seems uncomfortable.

Some doctors recommend keeping a bandage on the penis until it's healed, but others don't. (You'd need to change the bandage at each diaper change.) Sometimes a plastic ring is used instead of a bandage. This should drop off in five to eight days.

The most important thing is to keep your baby's penis as clean as possible while it's healing. Gently wash it with a clean washcloth, unscented soap, and water at each bath and diaper change.

Try to give your baby some diaper-free time every day to allow air to circulate around the penis while it's healing. Your baby's doctor may also suggest that you put petroleum jelly on the area to reduce irritation. The wound should heal in seven to 10 days.

During that time, the penis should look less red and swollen each day. You may notice a little watery, yellow discharge or crust around the wound during the first week – this is normal. But contact your baby's healthcare provider immediately if:

You notice any bleeding, or redness or swelling spreading down the shaft of the penis.

Does a circumcised penis require special care after it heals?

Sometimes, after a circumcision, a little bit of foreskin remains attached at the base of the head of the penis. You might not be able to tell whether your baby has any leftover foreskin. But if leftover foreskin is present, it may adhere to the head of the penis – and that may create a pocket of skin where bacteria can grow and cause infection.

To prevent this situation, your baby's doctor might recommend doing the following each time you change your son's diaper: Gently hold the head of the penis at its base and push the skin back. If there’s a fold of skin, clean underneath it with a wipe.

If leftover foreskin does adhere to the penis, the doctor may recommend waiting to see if it comes unstuck during a spontaneous erection or as your son grows. (You may be asked to apply a steroid cream.) If that doesn’t happen, the circumcision might have to be redone.

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